Healthcare Provider Details

I. General information

NPI: 1629006937
Provider Name (Legal Business Name): BRIDGE VIEW NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14310 20TH AVE
WHITESTONE NY
11357-3046
US

IV. Provider business mailing address

14310 20TH AVE
WHITESTONE NY
11357-3046
US

V. Phone/Fax

Practice location:
  • Phone: 718-961-1212
  • Fax: 718-461-9484
Mailing address:
  • Phone: 718-961-1212
  • Fax: 718-461-9484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7003309N
License Number StateNY

VIII. Authorized Official

Name: MR. MOSHE KALTER
Title or Position: PRESIDENT
Credential:
Phone: 718-961-1212